Chlamydia

Question 1

What factors increase the risk of chlamydia transmission?

Answer 1

• being young (under 25)
• multiple sexual partners
• sexually active from a young age

Question 2

How many cases of chlamydia are asymptomatic?

Answer 2

• 75% cases are asymptomatic in women
• 50% cases are asymptomatic in men
• asymptomatic patients can still pass on the infection

Question 3

What is involved in the National Chlamydia Screening Programme (NCSP)?

Answer 3

• every sexually active person under 25 should be screened annually

OR

• when they change their sexual partner
• everyone is retested after 3 months to ensure they have not contracted chlamydia again

Question 4

What are individuals tested for during an STI screening?

Answer 4

• chalmydia
• gonorrhoea
• syphilis (blood test)
• HIV (blood test)

Question 5

What are the 2 different types of swabs used in sexual health screening?

Answer 5

• charcoal swabs
• nucleic acid amplification test (NAAT) swabs

charcoal swab

Question 6

What are charcoal swabs used for?

Answer 6

• microscopy (looking at the sample under the microscope)
• culture (growing the organism)
• sensitivities (which antibiotics are effective)
• the Aimes transport medium in the tube keeps the micro-organisms alive during transport

Question 7

What organisms can be confirmed through use of a charcoal swab?

Answer 7

• a charcoal swab can be used for an endocervical** and **high vaginal swab (HVS)
• they can confirm:

1. bacterial vaginosis
2. candidiasis
3. gonorrhoea (endocervical swab)
4. trichomonas vaginalis (swab from posterior fornix)
5. group B streptococci

Question 8

How do NAAT swabs work?

What do they test for?

Answer 8

they check directly for the DNA or RNA of an organism

they are used specifically for chlamydia** or **gonorrhoea

OR to test specifically for mycoplasma genitalium

Question 9

How are NAAT swabs taken in women and men?

Answer 9

women:

• an endocervical swab is preferred
• can be taken as a vulvovaginal swab that the patient takes themselves

men:

• a first-catch urine sample is used
• urethral swab may be used in some situations

Question 10

When may additional NAAT swabs be considered?

Answer 10

rectal and/or pharyngeal NAAT swabs can diagnose chlamydia in the rectum or throat

(consider if anal / oral sex has taken place)

Question 11

What is done when gonorrhoea is demonstrated on a NAAT test?

Answer 11

endocervical charcoal swab

• this is required for MC&S

Question 12

How is a high vaginal swab and vulvovaginal swab taken?

Answer 12

high vaginal swab:

• swab is rotated for 10-15 seconds in the posterior fornix of the vagina

vulvovaginal swab:

• swab is rotated against the vaginal walls
• patient is able to perform this themselves

HVS

Question 13

How may symptomatic women with chlamydia present?

Answer 13

• abnormal vaginal discharge
• pelvic pain
• IMB or PCB
• dyspareunia
• dysuria

Question 14

How may symptomatic men with chlamydia present?

Answer 14

• urethral discharge or discomfort
• dysuria
• epididymo-orchitis
• reactive arthritis

Question 15

What are the typical examination findings in chlamydia?

Answer 15

• pelvic / abdominal tenderness
• cervical motion tenderness
• cervicitis (inflamed cervix)
• purulent discharge

Question 16

How is chlamydia diagnosed?

Answer 16

nucleic acid amplification test (NAAT):

• vulvovaginal / endocervical swab in women
• first-catch urine sample in men
• rectal / pharyngeal swabs for anal / oral sex

Question 17

What is the treatment for chlamydia?

Answer 17

doxycycline 100mg twice a day for 7 days

Question 18

When is doxycycline contraindicated?

What are the alternatives?

Answer 18

contraindicated in pregnancy + breastfeeding

• azithromycin, erythromycin or amoxicillin may be used

Question 19

When is a test of cure recommended for chlamydia?

Answer 19

• test of cure is not routinely recommended
• performed in rectal chlamydia, pregnancy or where symptoms persist

Question 20

What other advice should be given to patients with a chlamydia diagnosis?

Answer 20

• abstain from sex for 7 days to all partners to reduce risk of re-infection
• ways to prevent future infections
• contact tracing and notification of sexual partners

Question 21

What are the possible complications of chlamydia infection?

Answer 21

• PID
• chronic pelvic pain
• infertility
• ectopic pregnancy
• epididymo-orchitis
• conjunctivitis
• lymphogranuloma venereum
• reactive arthritis

Question 22

What are the pregnancy-related complications of chlamydia infection?

Answer 22

• preterm delivery
• premature rupture of membranes
• low birth weight
• postpartum endometritis
• neonatal infection (conjunctivitis + pneumonia)

Question 23

What is lymphogranuloma venereum (LGV)?

Answer 23

• affects the lymphoid tissue around the site of infection with chlamydia
• most commonly affects MSM

Question 24

What are the 3 stages of LGV?

Answer 24

primary stage:

• painless ulcer on the penis / vaginal wall / rectum

secondary stage:

• lymphadenitis - swelling, pain + inflammation in the infected lymph nodes
• tends to affect inguinal or femoral LNs

tertiary stage:

• inflammation of the rectum and anus (proctocolitis)
• proctocolitis results in pain, change in bowel habit, tenesmus + discharge

Question 25

What is the treatment for LGV?

Answer 25

doxycycline 100mg twice daily for 21 days

Question 26

How can chlamydial conjunctivitis occur?

Answer 26

* when genital fluid comes into contact with the eye * presents with **chronic erythema, irritation + discharge** * lasts for **more than 2 weeks** * usually **unilateral**

Question 27

What type of organism is chlamydia?

Answer 27

* **_gram-negative bacteria_** * it is an **intracellular organism** * *it replicates within cells before rupturing this and spreading to others*